Zheng Hongru,Wang Zhifen,Ma Junxing,et al.Effects of sedation depth on the nociceptive index and consciousness index during total intravenous anesthesia in children[J].Journal of Clinical Pediatric Surgery,,():174-180.[doi:10.3760/cma.j.cn101785-20251102-00035]
Effects of sedation depth on the nociceptive index and consciousness index during total intravenous anesthesia in children
- Keywords:
- Sedative; Total Intravenous Anesthesia; Nociception; Consciousness; Impact Assessment; Child
- Abstract:
- Objective To investigate the effects of different depths of sedation on the quantium nociceptive index (qNOX) and quantium consciousness index (qCON) during total intravenous anesthesia (TIVA) in children,and to evaluate the feasibility of regulating anesthetic maintenance based on qNOX/qCON monitoring. Methods This prospective randomized controlled trial included 150 pediatric patients who underwent elective tonsillar and adenoid radiofrequency ablation at Tianjin Children’s Hospital between July and October 2025.The patients were randomly divided into five groups (n=30 per group).Anesthesia induction was performed as follows:group A received sufentanil,propofol,and cisatracurium; groups B and D received additional midazolam at 0.02 mg/kg on the basis of group A; and groups C and E received additional midazolam at 0.04 mg/kg.For anesthesia maintenance,groups A,B,and C received continuous intravenous infusion of propofol at 10 mg·kg-1·h-1 and remifentanil at 0.083 μg·kg-1·min-1 until the end of surgery.In groups D and E,the propofol dose was reduced by half during adenoid ablation,while the remifentanil dose remained unchanged until the end of surgery.The qCON and qNOX values,hemodynamic parameters,and postoperative recovery were recorded at five time points:before induction (T0),before laryngoscopy (T1),5 minutes after the start of surgery (T2),at cessation of drug infusion (T3),and before extubation (T4). Results There were no significant differences in qNOX and qCON at T0,or in qNOX at T1 among the groups (P>0.05).Comparisons of qNOX/qCON at T2 and T3 showed that values in group A were higher than those in the other groups (P<0.05); values in group C were lower than those in group B (P<0.05),and values in group E were lower than those in group D (P<0.05).From T1 to T3,qNOX/qCON values increased in all groups,with the greatest increase observed in group A and the smallest increase in group C.At T3,qNOX/qCON values in groups D and E were higher than those in groups B and C,respectively (P<0.05).No cases of emergence agitation were observed in any patient. Conclusions The effects of sedation depth on qNOX/qCON values during pediatric TIVA are dose-dependent,and there is an interactive relationship between the qNOX and qCON indices.Under identical surgical stimulation,sedation level directly influences nociceptive monitoring feedback.With adequate neuromuscular blockade and appropriate sedation,qNOX can serve as an effective tool for assessing the suppression of surgical nociception in children.Combined interpretation of qCON and qNOX indices may be used to guide precise titration of anesthetic and analgesic agents,thereby optimizing intraoperative management during pediatric general anesthesia.
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Memo
收稿日期:2025-11-2。
基金项目:天津市卫生健康科技项目资助(TJWJ2025QN064);天津市医学重点学科建设资助(TJYXZDXK-3-016B)
通讯作者:王志芬,Email:wzf9001@126.com